Private medical insurance – the umbrella you can only open when it isn’t raining

We had some pretty good news today: the PET scan which Judy had a week ago suggests that her chemotherapy and radiotherapy treatment has dealt to her oesophageal cancer. I say ‘suggests’ because we can’t be absolutely certain. Judy’s brilliant (and lovely) radiation oncologist is pretty sure that what may look like residual cancer on the scan is in fact inflammation resulting from the dilation treatment she’s having to widen her constricted oesophagus. All good.

Not so good is the fact that Southern Cross, to which we have contributed tens of thousands of dollars over the years, won’t pay for the PET scan. They only pay out on one PET scan per claim year, from 1 August to 31 July, and this was Judy’s third  in the current year.

I’ll come back to this but first a little background.

After my failed attempt to win the Miramar seat for Labour in 1972, I found myself unemployed and seemingly unemployable. Newly elected Prime Minister Norman Kirk, a collector of grievances,  had no interest in assisting his former candidate and the outlook seemed bleak.

To the rescue came the Public Service Association, a haven for failed Labour Party candidates, under the enlightened leadership of then General Secretary Dan Long.  I was given a job as a PSA "advisory officer." My principal task during that period was to write a paper on private medical insurance.

I concluded in this paper that private medical insurance was a social evil since it created a two-tier system in which the rich could afford the very best in medical services and treatment, while the poor queued with their begging bowls for the reluctant largesse of the public health system. Stripped of the hyperbole, I still think that’s more or less still the case. If you can afford private medical insurance, you won’t  wait as long to be treated and you’ll suffer in considerably more comfort than you would in the public system.

Naturally, when I’d accumulated a bob or two, I signed up to Southern Cross, a "not for profit" supplier of medical insurance.

Somewhere in the dark distant past of my PSA job demonising private medical insurance, I remember coming across this sentence: "Private medical insurance is the umbrella you can only open when it isn’t raining." I think that’s not only elegant but true.

Private medical insurance is no more generous or humane or socially responsible  than any other sort of insurance. Basically when you need them most, when, metaphorically speaking, it’s not just raining but pissing down, they need and want you least. They express their disinterest by massively increasing your premiums. The rot sets in when you hit 65.

So Judy has oesophageal cancer. Absolutely central to her diagnosis and treatment is the PET scan. The PET scan is the most reliable way of telling you whether you’ve beaten the cancer, whether it’s still there but restricted to its original site, or whether, in the worst scenario, it has spread to other parts of the body, metastasised. You can only describe this as "vital information."

In the current claim year Judy has had three PET scans. Each PET scan costs roughly $2500. Southern Cross paid for the first and contributed a generous $95 to the second. The policyholders, Judy and Brian, forked out the rest.

Judy’s third PET scan was roughly a week ago. Its purpose was essentially to tell her whether the cancer has been beaten. I already knew Southern Cross wouldn’t be footing the bill. I’d taken an earlier call from one of its reps. He’d got saccharine sympathy down to a T. But the message was clear: One PET scan only per claim year. We won’t be paying the bill for this one or any more this year. The policyholders, Judy and Brian, will.

The fact of the matter is that Judy is probably going to need PET scans every three to six months to monitor the battle that is going on between her treatment and the cancer. But despite the honey-tongued apologies of its call-centre operator, Southern Cross really doesn’t give a stuff. It’s all about the cash.

What’s more, the policy doesn’t make financial sense. PET scans could save it money by identifying metastasis at an early stage when it can be most easily treated. Cost: $2500 per scan. That would seem to me more economic than spending a hundred grand or more on late-stage surgery or other treatment.

Well, I can read your mind, or at least some of your minds: This bastard should consider himself lucky that he can afford private medical insurance. And you’re probably right. In a first world country like New Zealand, quality medical treatment should be instantly available to every citizen regardless of income or assets. But we aren’t there yet and I’m buggered if my wife is going to get anything less than the best. I thought Southern Cross would provide that. It doesn’t.

As I discovered all those years ago, private medical insurance is the umbrella you can only open when it isn’t raining – or not pouring down at least.

Finally, to avoid any possible misunderstanding, all of the medical and medical support staff we’ve met on this journey – the doctors, nurses, radiologists, technicians, receptionists, telephonists – have been wonderful and, yes, just plain lovely. Thanks.

Media trainer and commentator Dr Brian Edwards posts at Brian Edwards Media.